|
HC ARWY ORAL INFANT SZ 2 LMA
|
Facility
|
IP
|
$49.69
|
|
| Hospital Charge Code |
901604970
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$19.88
|
| Rate for Payer: Galaxy Health WC |
$42.24
|
| Rate for Payer: Global Benefits Group Commercial |
$29.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.93
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$42.24
|
|
|
HC ARWY ORAL NEONATE SZ 1 LMA
|
Facility
|
IP
|
$49.69
|
|
| Hospital Charge Code |
901604968
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$19.88
|
| Rate for Payer: Galaxy Health WC |
$42.24
|
| Rate for Payer: Global Benefits Group Commercial |
$29.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.93
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$42.24
|
|
|
HC ARWY ORAL NEONATE SZ 1 LMA
|
Facility
|
OP
|
$49.69
|
|
| Hospital Charge Code |
901604968
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.51
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: Cigna of CA HMO |
$31.80
|
| Rate for Payer: Cigna of CA PPO |
$36.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$19.88
|
| Rate for Payer: Galaxy Health WC |
$42.24
|
| Rate for Payer: Global Benefits Group Commercial |
$29.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.78
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$42.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.84
|
| Rate for Payer: United Healthcare All Other HMO |
$24.84
|
| Rate for Payer: United Healthcare HMO Rider |
$24.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.24
|
| Rate for Payer: Vantage Medical Group Senior |
$42.24
|
|
|
HC ASAHI ASTATO XS 20 300CM
|
Facility
|
IP
|
$741.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812750
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.20 |
| Max. Negotiated Rate |
$629.85 |
| Rate for Payer: Adventist Health Commercial |
$148.20
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.40
|
| Rate for Payer: EPIC Health Plan Senior |
$296.40
|
| Rate for Payer: Galaxy Health WC |
$629.85
|
| Rate for Payer: Global Benefits Group Commercial |
$444.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$494.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$458.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.84
|
| Rate for Payer: Multiplan Commercial |
$592.80
|
| Rate for Payer: Networks By Design Commercial |
$481.65
|
| Rate for Payer: Prime Health Services Commercial |
$629.85
|
|
|
HC ASAHI ASTATO XS 20 300CM
|
Facility
|
OP
|
$741.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812750
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.20 |
| Max. Negotiated Rate |
$629.85 |
| Rate for Payer: Adventist Health Commercial |
$148.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$486.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$629.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$455.05
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Cigna of CA HMO |
$474.24
|
| Rate for Payer: Cigna of CA PPO |
$548.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$629.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$629.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$629.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.40
|
| Rate for Payer: EPIC Health Plan Senior |
$296.40
|
| Rate for Payer: Galaxy Health WC |
$629.85
|
| Rate for Payer: Global Benefits Group Commercial |
$444.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$494.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$458.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$518.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$518.70
|
| Rate for Payer: Multiplan Commercial |
$592.80
|
| Rate for Payer: Networks By Design Commercial |
$481.65
|
| Rate for Payer: Prime Health Services Commercial |
$629.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$444.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$444.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$370.50
|
| Rate for Payer: United Healthcare All Other HMO |
$370.50
|
| Rate for Payer: United Healthcare HMO Rider |
$370.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$370.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$629.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$629.85
|
| Rate for Payer: Vantage Medical Group Senior |
$629.85
|
|
|
HC ASPARAGUS IGE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913632
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$156.13 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.13
|
| Rate for Payer: Blue Shield of California Commercial |
$44.15
|
| Rate for Payer: Blue Shield of California EPN |
$29.17
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cigna of CA HMO |
$42.24
|
| Rate for Payer: Cigna of CA PPO |
$48.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC ASPARAGUS IGE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913632
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Senior |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
|
|
HC ASPIRATION/BLADDER BY NEEDLE
|
Facility
|
IP
|
$1,725.00
|
|
|
Service Code
|
CPT 51100
|
| Hospital Charge Code |
900501596
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,466.25 |
| Rate for Payer: Adventist Health Commercial |
$345.00
|
| Rate for Payer: Cash Price |
$776.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$690.00
|
| Rate for Payer: EPIC Health Plan Senior |
$690.00
|
| Rate for Payer: Galaxy Health WC |
$1,466.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,035.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,150.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$657.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,067.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.00
|
| Rate for Payer: Multiplan Commercial |
$1,380.00
|
| Rate for Payer: Networks By Design Commercial |
$1,121.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,466.25
|
|
|
HC ASPIRATION/BLADDER BY NEEDLE
|
Facility
|
OP
|
$1,725.00
|
|
|
Service Code
|
CPT 51100
|
| Hospital Charge Code |
900501596
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$99.03 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$345.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$776.25
|
| Rate for Payer: Cash Price |
$776.25
|
| Rate for Payer: Cash Price |
$776.25
|
| Rate for Payer: Cigna of CA HMO |
$1,104.00
|
| Rate for Payer: Cigna of CA PPO |
$1,276.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| Rate for Payer: Galaxy Health WC |
$1,466.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,035.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,150.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| Rate for Payer: Multiplan Commercial |
$1,380.00
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$1,121.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,466.25
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,035.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$862.50
|
| Rate for Payer: United Healthcare All Other HMO |
$862.50
|
| Rate for Payer: United Healthcare HMO Rider |
$862.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$862.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC ASPIRATION INJECTION INTERM JONT W US GUID
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
906620606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$220.00 |
| Max. Negotiated Rate |
$935.00 |
| Rate for Payer: Adventist Health Commercial |
$220.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.00
|
| Rate for Payer: EPIC Health Plan Senior |
$440.00
|
| Rate for Payer: Galaxy Health WC |
$935.00
|
| Rate for Payer: Global Benefits Group Commercial |
$660.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$733.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$419.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$680.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.00
|
| Rate for Payer: Multiplan Commercial |
$880.00
|
| Rate for Payer: Networks By Design Commercial |
$715.00
|
| Rate for Payer: Prime Health Services Commercial |
$935.00
|
|
|
HC ASPIRATION INJECTION INTERM JONT W US GUID
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
906620606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$137.63 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$220.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cigna of CA HMO |
$704.00
|
| Rate for Payer: Cigna of CA PPO |
$814.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$879.92
|
| Rate for Payer: Galaxy Health WC |
$935.00
|
| Rate for Payer: Global Benefits Group Commercial |
$660.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$137.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$733.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,108.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,179.09
|
| Rate for Payer: Multiplan Commercial |
$880.00
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$715.00
|
| Rate for Payer: Prime Health Services Commercial |
$935.00
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$660.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$879.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC ASPIRATION INJECTION MAJOR JONT W US GUID
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
906620611
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$153.30 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$220.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cigna of CA HMO |
$704.00
|
| Rate for Payer: Cigna of CA PPO |
$814.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$935.00
|
| Rate for Payer: Global Benefits Group Commercial |
$660.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$153.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$733.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$880.00
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$715.00
|
| Rate for Payer: Prime Health Services Commercial |
$935.00
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$660.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC ASPIRATION INJECTION MAJOR JONT W US GUID
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
906620611
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$220.00 |
| Max. Negotiated Rate |
$935.00 |
| Rate for Payer: Adventist Health Commercial |
$220.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.00
|
| Rate for Payer: EPIC Health Plan Senior |
$440.00
|
| Rate for Payer: Galaxy Health WC |
$935.00
|
| Rate for Payer: Global Benefits Group Commercial |
$660.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$733.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$419.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$680.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.00
|
| Rate for Payer: Multiplan Commercial |
$880.00
|
| Rate for Payer: Networks By Design Commercial |
$715.00
|
| Rate for Payer: Prime Health Services Commercial |
$935.00
|
|
|
HC ASPIRATION INJECTION SM JONT W US GUID
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
906620604
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.16 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$220.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cigna of CA HMO |
$704.00
|
| Rate for Payer: Cigna of CA PPO |
$814.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$935.00
|
| Rate for Payer: Global Benefits Group Commercial |
$660.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$127.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$733.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$880.00
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$715.00
|
| Rate for Payer: Prime Health Services Commercial |
$935.00
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$660.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC ASPIRATION INJECTION SM JONT W US GUID
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
906620604
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$220.00 |
| Max. Negotiated Rate |
$935.00 |
| Rate for Payer: Adventist Health Commercial |
$220.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.00
|
| Rate for Payer: EPIC Health Plan Senior |
$440.00
|
| Rate for Payer: Galaxy Health WC |
$935.00
|
| Rate for Payer: Global Benefits Group Commercial |
$660.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$733.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$419.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$680.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.00
|
| Rate for Payer: Multiplan Commercial |
$880.00
|
| Rate for Payer: Networks By Design Commercial |
$715.00
|
| Rate for Payer: Prime Health Services Commercial |
$935.00
|
|
|
HC ASPIRATION/INJ GANGLION CYSTS
|
Facility
|
IP
|
$1,238.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
909020036
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$247.60 |
| Max. Negotiated Rate |
$1,052.30 |
| Rate for Payer: Adventist Health Commercial |
$247.60
|
| Rate for Payer: Cash Price |
$557.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$495.20
|
| Rate for Payer: EPIC Health Plan Senior |
$495.20
|
| Rate for Payer: Galaxy Health WC |
$1,052.30
|
| Rate for Payer: Global Benefits Group Commercial |
$742.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$825.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$471.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$766.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.12
|
| Rate for Payer: Multiplan Commercial |
$990.40
|
| Rate for Payer: Networks By Design Commercial |
$804.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,052.30
|
|
|
HC ASPIRATION/INJ GANGLION CYSTS
|
Facility
|
OP
|
$1,238.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
909020036
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$103.28 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$247.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$557.10
|
| Rate for Payer: Cash Price |
$557.10
|
| Rate for Payer: Cash Price |
$557.10
|
| Rate for Payer: Cigna of CA HMO |
$792.32
|
| Rate for Payer: Cigna of CA PPO |
$916.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$1,052.30
|
| Rate for Payer: Global Benefits Group Commercial |
$742.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$825.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$990.40
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$804.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,052.30
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$742.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$619.00
|
| Rate for Payer: United Healthcare All Other HMO |
$619.00
|
| Rate for Payer: United Healthcare HMO Rider |
$619.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$619.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC ASPIRATION/INJ GANGLION CYSTS
|
Facility
|
IP
|
$1,238.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
909020036
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$247.60 |
| Max. Negotiated Rate |
$1,052.30 |
| Rate for Payer: Adventist Health Commercial |
$247.60
|
| Rate for Payer: Cash Price |
$557.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$495.20
|
| Rate for Payer: EPIC Health Plan Senior |
$495.20
|
| Rate for Payer: Galaxy Health WC |
$1,052.30
|
| Rate for Payer: Global Benefits Group Commercial |
$742.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$825.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$471.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$766.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.12
|
| Rate for Payer: Multiplan Commercial |
$990.40
|
| Rate for Payer: Networks By Design Commercial |
$804.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,052.30
|
|
|
HC ASPIRATION/INJ GANGLION CYSTS
|
Facility
|
OP
|
$1,238.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
909020036
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$91.32 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$247.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$557.10
|
| Rate for Payer: Cash Price |
$557.10
|
| Rate for Payer: Cash Price |
$557.10
|
| Rate for Payer: Cigna of CA HMO |
$792.32
|
| Rate for Payer: Cigna of CA PPO |
$916.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$1,052.30
|
| Rate for Payer: Global Benefits Group Commercial |
$742.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$91.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$825.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$990.40
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$804.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,052.30
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$742.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC ASPIRATOR MECONIUM
|
Facility
|
OP
|
$717.60
|
|
| Hospital Charge Code |
901602312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.52 |
| Max. Negotiated Rate |
$609.96 |
| Rate for Payer: Adventist Health Commercial |
$143.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$470.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$609.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$394.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$538.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$440.68
|
| Rate for Payer: Cash Price |
$322.92
|
| Rate for Payer: Cigna of CA HMO |
$459.26
|
| Rate for Payer: Cigna of CA PPO |
$531.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$609.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$609.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$609.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$287.04
|
| Rate for Payer: EPIC Health Plan Senior |
$287.04
|
| Rate for Payer: Galaxy Health WC |
$609.96
|
| Rate for Payer: Global Benefits Group Commercial |
$430.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$478.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$273.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$444.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$502.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.32
|
| Rate for Payer: Multiplan Commercial |
$574.08
|
| Rate for Payer: Networks By Design Commercial |
$466.44
|
| Rate for Payer: Prime Health Services Commercial |
$609.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$430.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$430.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$358.80
|
| Rate for Payer: United Healthcare All Other HMO |
$358.80
|
| Rate for Payer: United Healthcare HMO Rider |
$358.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$358.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$609.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$609.96
|
| Rate for Payer: Vantage Medical Group Senior |
$609.96
|
|
|
HC ASPIRATOR MECONIUM
|
Facility
|
IP
|
$717.60
|
|
| Hospital Charge Code |
901602312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.52 |
| Max. Negotiated Rate |
$609.96 |
| Rate for Payer: Adventist Health Commercial |
$143.52
|
| Rate for Payer: Cash Price |
$322.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$287.04
|
| Rate for Payer: EPIC Health Plan Senior |
$287.04
|
| Rate for Payer: Galaxy Health WC |
$609.96
|
| Rate for Payer: Global Benefits Group Commercial |
$430.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$478.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$273.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$444.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.22
|
| Rate for Payer: Multiplan Commercial |
$574.08
|
| Rate for Payer: Networks By Design Commercial |
$466.44
|
| Rate for Payer: Prime Health Services Commercial |
$609.96
|
|
|
HC ASPIR INJECT THYROID CYST
|
Facility
|
OP
|
$4,958.00
|
|
|
Service Code
|
CPT 60300
|
| Hospital Charge Code |
909020010
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.87 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$991.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,231.10
|
| Rate for Payer: Cash Price |
$2,231.10
|
| Rate for Payer: Cash Price |
$2,231.10
|
| Rate for Payer: Cigna of CA HMO |
$3,173.12
|
| Rate for Payer: Cigna of CA PPO |
$3,668.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$4,214.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,974.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,306.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,189.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$3,966.40
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$3,222.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,214.30
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,974.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,479.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,479.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,479.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,479.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC ASPIR INJECT THYROID CYST
|
Facility
|
OP
|
$4,958.00
|
|
|
Service Code
|
CPT 60300
|
| Hospital Charge Code |
909020010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$141.36 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$991.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$2,231.10
|
| Rate for Payer: Cash Price |
$2,231.10
|
| Rate for Payer: Cash Price |
$2,231.10
|
| Rate for Payer: Cigna of CA HMO |
$3,173.12
|
| Rate for Payer: Cigna of CA PPO |
$3,668.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$4,214.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,974.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$141.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,306.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,189.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$3,966.40
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$3,222.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,214.30
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,974.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC ASPIR INJECT THYROID CYST
|
Facility
|
IP
|
$4,958.00
|
|
|
Service Code
|
CPT 60300
|
| Hospital Charge Code |
909020010
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$991.60 |
| Max. Negotiated Rate |
$4,214.30 |
| Rate for Payer: Adventist Health Commercial |
$991.60
|
| Rate for Payer: Cash Price |
$2,231.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,983.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,983.20
|
| Rate for Payer: Galaxy Health WC |
$4,214.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,974.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,306.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,889.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,069.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,189.92
|
| Rate for Payer: Multiplan Commercial |
$3,966.40
|
| Rate for Payer: Networks By Design Commercial |
$3,222.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,214.30
|
|
|
HC ASPIR INJECT THYROID CYST
|
Facility
|
IP
|
$4,958.00
|
|
|
Service Code
|
CPT 60300
|
| Hospital Charge Code |
909020010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$991.60 |
| Max. Negotiated Rate |
$4,214.30 |
| Rate for Payer: Adventist Health Commercial |
$991.60
|
| Rate for Payer: Cash Price |
$2,231.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,983.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,983.20
|
| Rate for Payer: Galaxy Health WC |
$4,214.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,974.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,306.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,889.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,069.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,189.92
|
| Rate for Payer: Multiplan Commercial |
$3,966.40
|
| Rate for Payer: Networks By Design Commercial |
$3,222.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,214.30
|
|
